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M S Chang

Publications and source records attributed to M S Chang.

At least 199 records · Page 11Linked to original sources
PubMed1996

Dual AV node pathway physiology in patients with Wolff-Parkinson-White syndrome.

Published data on the relationship between dual AV node pathway physiology, locations and numbers of accessory pathways are limited. The purpose of this study is to appraise the dual AV node pathway physiology in a large group of patients with accessory AV pathways. A consecutive series of 759 patients was included for analysis. The incidence of antegrade or retrograde dual AV node pathway physiology and AV node reentrant tachycardia was similar for patients with accessory pathway at different locations. However, the incidence of bidirectional dual AV node pathway physiology (11.1%) and fast-slow type AV node reentrant echo (8.3%) was significantly higher in anteromidseptal accessory pathways. The incidence of antegrade (24.2% vs. 30.8%, P > 0.05), retrograde (4.9% vs. 2.9%, P > 0.05) and bidirectional dual AV node pathway physiology (3.0% vs. 2.9%, P > 0.05) was similar between the patients with a single pathway and multiple accessory pathways. Furthermore, the patients with multiple accessory pathways had a higher incidence of slow-fast form AV node reentrant tachycardia (8.8% vs. 3.0%, P = 0.034) and fast-slow form AV node reentrant echo (8.8% vs. 2.7%, P = 0.02). Thirty-four patients (4.5%) received slow pathway ablation for AV node reentrant tachycardia and none had recurrent tachycardia during the follow up period (26 +/- 7, range 1-56 months). We conclude that it is possible to find dual AV node pathway physiology in patients with accessory pathways because this phenomenon was not rare, especially in patients with a single pathway located in the anteromidseptal area or in patients with multiple accessory pathways.

Adult↗
PubMed1996

Purification and molecular cloning of an 8R-lipoxygenase from the coral Plexaura homomalla reveal the related primary structures of R- and S-lipoxygenases.

Lipoxygenases that form S configuration fatty acid hydroperoxides have been purified or cloned from plant and mammalian sources. Our objectives were to characterize one of the lipoxygenases with R stereospecificity, many of which are described in marine and freshwater invertebrates. Characterization of the primary structure of an R-specific enzyme should help provide a new perspective to consider the enzyme-substrate interactions that are the basis of the specificity of all lipoxygenases. We purified an 8R-lipoxygenase of the prostaglandin-containing coral Plexaura homomalla by cation and anion exchange chromatography. This yielded a colorless enzyme preparation, a band of approximately 100 kDa on SDS-polyacrylamide gel electrophoresis, and turnover numbers of 4000 min-1 of 8R-lipoxygenase activity in peak chromatographic fractions. The full-length cDNA was cloned by PCR using peptide sequence from the purified protein and by 5'- and 3'-rapid amplification of cDNA ends. The cDNA encodes a polypeptide of 715 amino acids, including over 70 amino acids identified by peptide microsequencing. A peptide presequence of 52 amino acids is cleaved to give the mature protein of 76 kDa; the difference from the estimated size by SDS-PAGE implies a post-translational modification of the P. homomalla enzyme. All of the iron-binding histidines of S-lipoxygenases are conserved in the 8R-lipoxygenase. However, the C-terminal amino acid is a threonine, as opposed to the isoleucine that provides the carboxylate ligand to the iron in all known S-lipoxygenases. These results establish that the 8R-lipoxygenase is related in primary structure to the S-lipoxygenases. A model of the basis of R and S stereospecificity is described.

Amino Acid Sequence↗
PubMed1996

Prevalence of coronary heart disease in Kin-Chen, Kinmen.

We estimated the prevalence of coronary heart disease (CHD) by the Minnesota code of a 12-lead resting electrocardiogram, Rose chest pain questionnaire and self-reported previous medical history in Kin-Chen, Kinmen (Quemoy), an island under military control for 40 years and the focal point of confrontation between mainland China and Taiwan. Among the target population of 6346 who accounted for all residents aged over 30, 3826 (60.3%) responded with complete data. The prevalence of probable CHD (Minnesota code 1.1-1.2) was 4.1% (71/1732) in men and 4.0% (84/2094) in women, whereas the prevalence of possible CHD (Minnesota code 1.3, 4.1-4.4, 5.1-5.3 and 7.1.1) was significantly higher in women (21.4%) than in men (11.6%). When compared to Chinese populations elsewhere, the increased overall prevalence may suggest a link to long-term stress conditions under military control. We also found the abnormal ECG was associated with many risk factors of CHD, particularly win women. The prevalence of Rose angina and self-reported angina or myocardial infarction was, however, low and associated poorly with any cardiovascular risk factors. Long-term follow-up studies are needed to determine the predictive value of these electrocardiographic abnormalities for cardiovascular disease morbidity and mortality in this population.

Adult↗
PubMed1996

Co-existence of atrial tachycardia and common atrial flutter: electrophysiological characteristics and radiofrequency catheter ablation.

Four patients, who had no prior atrial surgery, underwent radiofrequency ablation for clinically documented typical atrial flutter. In addition to typical atrial flutter re-entrant atrial tachycardia was initiated during electrophysiological study in these four patients. We used earliest atrial endocardial activation and concealed entrainment pace mapping with short stimulus-P interval (< 40 ms) to identify the exit site of slow conduction are of atrial flutter were located at the posteromedial right atrium between the coronary ostium and the tricuspid annulus and those of slow conduction area of atrial tachycardia were located at high lateral right atrium in all four patients. Radiofrequency energy applied to these exit sites successfully eliminated both atrial flutter and atrial tachycardia in these four patients. Typical atrial flutter and re-entrant atrial tachycardia with two distinct re-entrant circuits concomitantly occurring in patients without prior atrial surgery are rare. Radiofrequency ablation can abolish both atrial tachyarrhythmias in the same ablation session.

Aged↗
PubMed1996

Genistein directly inhibits L-type calcium currents but potentiates cAMP-dependent chloride currents in cardiomyocytes.

We have examined the possible modulatory effects of genistein, a specific tyrosine kinase inhibitor, on cardiac L-type calcium currents and cAMP-dependent chloride currents in guinea pig ventricular myocytes. With one-suction electrode voltage-clamp technique, genistein dose-dependently and reversibly inhibited L-type calcium currents in cardiomyocytes (Km = 17.5 microM). Neither threshold potential nor the peak potential of current-voltage relationship was affected. Interestingly, daidzein (an inactive analogue of genistein) also depressed L-type calcium currents. When L-type calcium currents were directly activated by Bay K 8644, genistein was able to exert an inhibitory action. In contrast, genistein potentiated cardiac cAMP-dependent chloride currents activated by either isoproterenol or 3-isobutyl-1-methylxanthine. These results suggest that genistein may directly inhibit L-type calcium currents but may potentiate cAMP-dependent chloride currents in the heart.

1-Methyl-3-isobutylxanthine↗
PubMed1996

Longitudinal clinical and electrophysiological assessment of patients with symptomatic Wolff-Parkinson-White syndrome and atrioventricular node reentrant tachycardia.

BACKGROUND: Functional changes of the accessory AV pathways and dual AV node pathways are very important for patients with Wolff-Parkinson-White syndrome or AV node reentrant tachycardia who refuse to receive long-term medication or radiofrequency catheter ablation. However, no studies of serial clinical and electrophysiological characteristics in these patients have been performed. METHODS AND RESULTS: One hundred thirteen patients with Wolff-Parkinson-White syndrome or AV node reentrant tachycardia were included in this study. The first and second follow-up electrophysiological studies were performed in years 5 and 10 after the baseline study, respectively. Conduction properties of the accessory pathways became poor over time. After a mean follow-up period of 9 +/- 1 years, antegrade ventricular preexcitation and retrograde accessory pathway conduction disappeared in 22.5% and 7.8% (P < .01), respectively; dual AV node pathway physiology persisted and retrograde fast pathway disappeared in 10.8% of the patients. Baseline conduction properties of the antegrade and retrograde accessory pathways and the retrograde fast pathway independently predicted late loss of conduction. Spontaneous disappearance of the original tachyarrhythmias occurred in 10.3% of all patients, and newly developed tachyarrhythmias in 15.2%. The incidence (38.5%) of newly developed atrial fibrillation was significantly higher in patients with manifest accessory pathways. Furthermore, symptom scores and attack frequency increased significantly over time in the patients with accessory pathways and AV node reentrant tachycardia. CONCLUSIONS: Disappearance of the original tachycardia and changing patterns of tachycardia, also with an increase in symptom scores and attack frequency, suggested that a detailed evaluation of these events is important and early intervention with radiofrequency ablation would be helpful.

Adolescent↗
PubMed1996

Electrophysiological mechanisms in successful radiofrequency catheter modification of atrioventricular junction for patients with medically refractory paroxysmal atrial fibrillation.

BACKGROUND: Mechanisms and changes of electrophysiological (EP) characteristics in successful radiofrequency (RF) modification of right midseptal and posteroseptal areas for controlling rapid ventricular response to atrial fibrillation (Af) are not clear. METHODS AND RESULTS: We studied 50 patients with medically refractory paroxysmal Af. Group 1 consisted of 40 patients without dual atrioventricular (AV) node physiology with modification sites located in the mid/posteroseptal area. Of the 40 patients, 36 had successful modification (follow-up of 14 +/- 8 months), and 3 had AV block. Late follow-up electrophysiological study (98 +/- 10 days) showed pattern 1 (67%) with prolongation of AV node effective refractory period (ERP, > or =40 milliseconds) and Wenckebach block cycle length (WBCL, > or =40 milliseconds); pattern 2 (22%) with prolongation of AH interval (> or =20 milliseconds), ERP, and WBCL; and pattern 3 (11%) without any change in AV node conduction parameter. Change in ventricular rate negatively correlated with change of WBCL in patterns 1 (r=-.691, P=.019) and 2 (r=-.90, P=.01). Group 2 consisted of 10 patients with dual AV node pathway; elimination of slow pathway property was performed. Late follow-up electrophysiological study (92+/-7 days) showed that change in ventricular rate negatively correlated with change in AV node ERP (r=-.926, P=.0001) and WBCL (r=-.969, P=.0001). Four patients without significant modification effect had success after RF energy was delivered to higher levels (follow-up, 15+/-7 months). CONCLUSIONS: RF modification of right mid/posteroseptal area is feasible in 92% of patients with paroxysmal Af. Mechanisms of successful modification might be elimination of posterior input and/or partial injury of the compact node. Furthermore, simple elimination of slow pathway might be inadequate for control of ventricular rate in patients with little difference in conduction properties between fast and slow pathways.

Adult↗
PubMed1996

Drug-induced torsades de pointes in one patient with congenital long QT syndrome.

Although uncommon, torsades de pointes (TdP) associated with astemizole and/or erythromycin use have been reported previously. We describe a 30-year-old woman who had congenital prolongation of QT interval and TdP occurred after taking astemizole and erythromycin. Temporary cardiac pacing was successful in suppressing TdP. Prolongation of QT interval had good response to oral propranolol.

Adult↗
PubMed1996

Radiofrequency catheter ablation of common atrial flutter: comparison of electrophysiologically guided focal ablation technique and linear ablation technique.

OBJECTIVES: The purpose of this study was to study electrophysiologic characteristics and compare the electrophysiologically guided focal ablation technique and linear ablation technique in patients with common atrial flutter in a prospective randomized fashion. Background. Catheter ablation of the common atrial flutter circuit can be performed with different techniques. To date, these two techniques have not been compared prospectively in a randomized study. METHODS: Sixty patients with drug-refractory common atrial flutter were randomly assigned to undergo radiofrequency catheter ablation performed with the electrophysiologically guided focal ablation (Group I) or linear ablation technique (Group II). In Group I, radiofrequency energy was delivered to the site characterized by concealed entrainment with a short stimulus-P wave interval (<40 ms) and a postpacing interval equal to the atrial flutter cycle length. In Group II, continuous migratory application of radiofrequency energy was used to create two linear lesions in or around the inferior vena cava-tricuspid ring isthmus. Serial 24-h ambulatory electrocardiographic (Holter) and follow-up electrophysiologic studies were performed to assess recurrence of tachycardia and possible atrial arrhythmogenic effects. RESULTS: Successful elimination of the flutter circuit was achieved in 28 of 30 patients in Group I and 29 of 30 patients in Group II. More atrial premature beats and episodes of short run atrial tachyarrhythmias in the early period (within 2 weeks) after ablation were found in Group II. Recurrence rate (2 of 28 vs. 3 of 29) and incidence of new sustained atrial tachyarrhythmias (3 of 28 vs. 3 of 29) was similar in the two groups. Occurrence of recurrent atrial flutter and new sustained atrial tachyarrhythmias was related to associated cardiovascular disease and atrial enlargement in both groups. However, in Group II, the procedure time (104 +/- 17 vs. 181 +/- 29 min, p<0.01) were significantly shorter than those in Group I. CONCLUSIONS: Radiofrequency ablation of the common atrial flutter circuit was safe and effective with either the electrophysiologically guided focal ablation or linear ablation technique. However, the linear ablation technique was time-saving.

Aged↗
PubMed1996

Prediction of successful ablation site of concealed posteroseptal accessory pathways by a novel algorithm using baseline electrophysiological parameters: implication for an abbreviated ablation procedure.

BACKGROUND: Radiofrequency catheter ablation of concealed posteroseptal accessory pathways (APS) has been a relatively difficult task for electrophysiologists. Without a detailed mapping procedure, the left versus the right posteroseptal AP could not be distinguished. We investigated the electrophysiological characteristics of concealed posteroseptal APs and defined criteria from baseline parameters to predict the successful ablation site. Validity of the criteria was prospectively verified. METHODS AND RESULTS: Eighty-nine consecutive patients with a single concealed posteroseptal AP underwent successful radiofrequency catheter ablation. Of the initial 48 patients (group 1), the right posteroseptal area was first mapped. If no ideal electrogram could be obtained, or after several ineffective radiofrequency pulses, the left posteroseptal area was then mapped. Special attention was paid to the stability of the coronary sinus catheter with the most proximal electrode straddling the ostium, verified by coronary sinus venography, in all patients. Six patients (12.5%) had the earliest retrograde atrial activation at the middle electrode of the coronary sinus catheter, and successful ablation could only be achieved at the left posteroseptal area. For patients who presented with the earliest atrial activation at the proximal electrode, the presence of long RP' tachycardia suggested a right endocardial approach, while the delta VA (defined as the difference in the VA intervals between that recorded at the His bundle catheter and that at one of the electrode groups recording the earlier atrial activation) >-25 ms during tachycardia suggested a left endocardial approach. The subsequent 41 patients (group 2) were randomized into two subgroups. The initial mapping site was guided by the algorithm in group 2B, while it was not in group 2A. The successful ablation site could be predicted accurately in 18 (90%) of the 20 patients in group 2B. The radiofrequency pulses, ablation time, and fluoroscopic time were markedly reduced in Group 2B, mainly because of the omission of unnecessary mapping procedure in the right posteroseptal area in patients with "left atrio-left ventricular" fibers. CONCLUSIONS: By the algorithm based on baseline electrophysiological parameters, the successful ablation site could be accurately predicted in a majority of patients with concealed posteroseptal APs. Radiofrequency pulses, ablation time, and fluoroscopic time were markedly reduced.

Adult↗
PubMed1996

Cytochrome P450-dependent transformations of 15R- and 15S-hydroperoxyeicosatetraenoic acids: stereoselective formation of epoxy alcohol products.

Although there are many reports of epoxy alcohol synthesis from lipoxygenase products (fatty acid hydroperoxides) in mammalian tissues, there are no well-defined examples of the stereoselective synthesis of individual epoxy alcohol diastereomers. An earlier report on the metabolism of 15S-hydroperoxyeicosatetraenoic acid (15S-HPETE) in rat liver microsomes suggested such a specific reaction [Weiss, R. H., et al. (1987) Arch. Biochem. Biophys. 252, 334-338]. To characterize this reaction further, we set out to determine the precise structures and mechanism of biosynthesis of the epoxy alcohol products. We compared the products formed from 15R- and 15S-HPETE by hematin (a nonenzymatic reaction), by liver microsomes isolated from control and phenobarbital-treated rats, and by purified cytochrome P450 2B1. Eight epoxy alcohol isomers were identified by mass spectrometry and 1H NMR. In the hematin reaction, the major products are four epoxy alcohols with the epoxide in the trans configuration, diastereomers are formed in similar amounts, and the 15-HPETE enantiomers give indistinguishable patterns of products. By contrast, the liver microsomes and P450 2B1 enzyme form predominantly single diastereomers, and the configuration of the epoxide is dependent on the stereochemistry of the substrate. The main product formed from 15S-HPETE is 11S-hydroxy-14S,15S-trans-epoxyeicosa-5Z,8Z,12E- trienoic acid, and the amounts increase upon phenobarbital induction. The main products from 15R-HPETE are 11-hydroxy-14S,15R-epoxyeicosa-5Z,8Z,12E-t rienoic acid from microsomes from control rats and 13-hydroxy-14S,15R-cis-epoxyeicosa-5,8,11-trienoic acid in microsomes from phenobarbital-induced rats. The P450 2B1 enzyme gave products similar to those from the phenobarbital-induced microsomes. Analysis of an incubation using the 18O-labeled 15S-HPETE substrate demonstrated 97.6% retention of both hydroperoxy oxygens in the major product with progressively lower 18O retentions in the minor products (74-32%), possibly reflecting degrees of enzymatic control of these reactions. These results establish a precedent for the stereoselective synthesis of epoxy alcohols by mammalian cytochrome P450s.

Alcohols↗
PubMed1996

Complications of diagnostic electrophysiologic studies and radiofrequency catheter ablation in patients with tachyarrhythmias: an eight-year survey of 3,966 consecutive procedures in a tertiary referral center.

Predictors and comparisons of complications in patients with electrophysiologic study or radiofrequency ablation have not been assessed in previous published reports. The purpose of this study was to prospectively evaluate the procedure-specific complications and investigate the possible causes and predictors of complications in electrophysiologic study and radiofrequency ablation. Data of diagnostic electrophysiologic studies and radiofrequency ablation were prospective, and represented a consecutive series of 2,593 patients with 3,966 procedures. The present study showed that a significantly higher complication rate occurred in radiofrequency ablation than in electrophysiologic study (3.1% vs. 1.1%, respectively, p = 0.00002) and a significantly higher complication rate occurred in elderly than in young patients with electrophysiologic study (2.2% vs 0.5%, p = 0.0002) or radiofrequency ablation (6.1% vs 2.0%, p = 0.00015). Multiple logistic analysis found that older age (p < 0.01) and systemic disease in elderly patients (p < 0.01) were the independent predictors of complications in both procedures. Furthermore, there was no temporal trend in the incidence of complication. We conclude that the incidence of complication was higher in radiofrequency ablation, and elderly patients had a higher incidence of complications in both electrophysiologic study and radiofrequency ablation; these procedures, when performed by experienced personnel in an appropriately staffed and equipped laboratory, can be undertaken with an acceptable risk.

Adult↗
PubMed1996

Electrophysiologic characteristics and radiofrequency catheter ablation in patients with multiple atrioventricular nodal reentry tachycardias.

Information about the mechanism and radiofrequency catheter ablation of multiple atrioventricular (AV) nodal reentry tachycardias is limited. Among the 550 consecutive patients with AV nodal reentry tachycardia, 36 with multiple forms of AV nodal reentry tachycardia were included in this study. Electrophysiologic characteristics, as well as the efficacy and safety of radiofrequency ablation, were evaluated. Results showed that anterograde dual pathways were seen in 32 patients and triple pathways in 2, and retrograde dual pathways were seen in 23 patients and triple pathways in 11. Twenty-two patients had 2 types, 7 had 3 types, 5 had 4 types, and 2 had 5 types of AV nodal reentry tachycardia and echoes. After delivering radiofrequency energy to the target sites, 32 patients had no induction of AV nodal reentry tachycardia and only 4 had induction of 1 echo. Furthermore, 22 patients (61%) had simultaneous elimination or modification of the slow and/or intermediate pathways in the anterograde and retrograde direction. During the follow-up period of 19 +/- 14 months, 2 patients had recurrence of tachycardia. Thus, multiple anterograde and retrograde AV nodal pathways were present in the human AV node and they constituted the substrates of reentry circuits. Radiofrequency catheter ablation was safe and effective in eliminating the slow and intermediate pathways for maintenance of multiple AV nodal reentry tachycardias.

Adult↗
PubMed1996

Macrophage-stimulating protein, a ligand for the RON receptor protein tyrosine kinase, suppresses myeloid progenitor cell proliferation and synergizes with vascular endothelial cell growth factor and members of the chemokine family.

Macrophage-stimulating protein (MSP), originally identified as an inducer of murine resident macrophage responsiveness to chemoattractants, is a ligand for human RON/murine STK receptor protein tyrosine kinases. Since STK was cloned from populations enriched for hematopoietic stem cells, we initiated studies on the effects of MSP on colony formation by granulocyte-macrophage (CFU-GM), erythroid (BFU-E), and multipotential (CFU-GEMM) myeloid progenitor cells. MSP alone had no colony stimulating activity. However, MSP caused about a 50% suppression of CFU-GM colony formation induced by synergistic combinations of SLF or Flt-L plus GM-CSF, G-CSF, or IL-3 and of BFU-E and CFU-GEMM colonies induced by SLF or Flt3-L plus Epo or Epo and IL-3. In contrast, MSP had no effect on progenitors stimulated by one growth factor. MSP also suppressed colony formation by stimulated cord blood progenitors, but only after preinduction to a rapidly cycling state. It was previously reported that several members of the chemokine family synergistically suppress myeloid progenitor proliferation. Likewise, synergistic suppression was observed when MSP was paired with VEGF, MIP-1 alpha, IL-8, PF4, MCP-1, IP-10, or ENA-78, or when VEGF was paired with the chemokines; and the required MSP concentration was more than 100-fold less than for MSP alone. Additionally, MSP or VEGF inhibited proliferation of the human myeloid growth factor-dependent cell line, M07e, but a sustained effect required multiple additions over time. At the least, some of the MSP suppressive effects on myeloid progenitors, as assessed on single isolated CD34 marrow cells, appeared to be directly on the progenitors; sustained additions of MSP were required to see this effect. The suppressive action of MSP and its synergism with proteins of the chemokine family may be of relevance to regulation of blood cell production.

Bone Marrow Cells↗
PubMed1996

Efficiency of heating during radiofrequency catheter ablation of accessory atrioventricular pathways.

Adequate heating with myocardial thermal injury is necessary for successful ablation. This study was designed to examine the relationship between power, temperature, and efficiency of heating during radiofrequency catheter ablation of accessory pathways in 76 patients. During each application of radiofrequency energy, temperature was continually monitored by use of an ablation catheter with a thermistor embedded in the tip of the distal electrode. The efficiency of heating varied by location, with the greatest efficiency of heating for posteroseptal energy applications (2.7 +/- 2.3 degrees C/W), which were significantly greater than for left-sided (2.1 +/- 1.9 degrees C/W, P < 0.01) or right-sided (1.0 +/- 1.1 degrees C/W, P < 0.01) applications. For patients with left free wall and posteroseptal pathways, the temperature, radiofrequency power, time to peak temperature and efficiency of heating were similar between the successful and unsuccessful pulses. However, the mean temperature (53.5 +/- 4.5 vs. 45.1 +/- 5.1 degrees C, P < 0.01) and radiofrequency power (49.6 +/- 5.2 vs. 40.3 +/- 10.2 watt, P < 0.05) differed significantly between the successful and unsuccessful ablation pulses in patients with right free wall pathways. To achieve greater efficiency of heating and higher temperature, it is reasonable to use higher power outputs (40-50 W) in radiofrequency ablation of right free wall pathways, whereas less power outputs (30-40 W) are likely to produce adequate heating of posteroseptal and left free wall pathways, and minimize the risk of impedance rise and coagulum formation.

Adolescent↗
PubMed1996

Multiple anterograde atrioventricular node pathways in patients with atrioventricular node reentrant tachycardia.

OBJECTIVES: This study sought to investigate electrophysiologic characteristics and possible anatomic sites of multiple anterograde slow atrioventricular (AV) node pathways and to compare these findings with those in dual anterograde AV node pathways. BACKGROUND: Although multiple anterograde AV node pathways have been demonstrated by the presence of multiple discontinuities in the AV node conduction curve, the role of these pathways in the initiation and maintenance of AV node reentrant tachycardia (AVNRT) is still unclear, and possible anatomic sites of these pathways have not been reported. METHODS: This study included 500 consecutive patients with AVNRT who underwent electrophysiologic study and radiofrequency ablation. Twenty-six patients (5.2%) with triple or more anterograde AV node pathways were designated as Group I (16 female, 10 male, mean age 48 +/- 14 years), and the other 474 patients (including 451 with and 23 without dual anterograde AV node pathways) were designated as Group II (257 female, 217 male; mean age 52 +/- 16 years). RESULTS: Of the 21 patients with triple anterograde AV node pathways, AVNRT was initiated through the first slow pathway only in 3, through the second slow pathway only in 8 and through the two slow pathways in 9. Of the five patients with quadruple anterograde AV node pathways, AVNRT was initiated through all three anterograde slow pathways in three and through the two slower pathways (the second and third slow pathways) in two. After radiofrequency catheter ablation, no patient had inducible AVNRT. Eleven patients (42.3%) in Group I had multiple anterograde slow pathways eliminated simultaneously at a single ablation site. Eight patients (30.7%) had these slow pathways eliminated at different ablation sites; the slow pathways with a longer conduction time were ablated more posteriorly in the Koch's triangle than those with a shorter conduction time. The remaining seven patients (27%) had a residual slow pathway after delivery of radiofrequency energy at a single or different ablation sites. The patients in Group I had a longer tachycardia cycle length, poorer retrograde conduction properties and a higher incidence of multiple types of AVNRT than those in Group II. CONCLUSIONS: Multiple anterograde AV node pathways are not rare in patients with AVNRT. However, not all of the anterograde slow pathways were involved in the initiation and maintenance of tachycardia. Radiofrequency catheter ablation was safe and effective in eliminating critical slow pathways to cure AVNRT.

Adult↗
PubMed1996

Electrophysiologic characteristics, electropharmacologic responses and radiofrequency ablation in patients with decremental accessory pathway.

OBJECTIVES: This study sought to characterize the functional properties of decremental accessory atrioventricular (AV) pathways and to investigate their pharmacologic responses. BACKGROUND: Although decremental AV pathways associated with incessant reciprocating tachycardia have been studied extensively, information about the electrophysiologic characteristics and pharmacologic responses of anterograde and retrograde decremental AV pathways is limited. METHODS: Of 759 consecutive patients with accessory pathway-mediated tachyarrhythmia, 74 with decremental AV pathways were investigated (mean age 43 +/- 18 years). After baseline electrophysiologic study, the serial drugs adenosine, verapamil and procainamide were tested during atrial and ventricular pacing. Finally, radiofrequency catheter ablation was performed. RESULTS: Five patients had anterograde decremental conduction over the accessory pathway but had no retrograde conduction. Of the 64 patients with retrograde decremental conduction over the accessory pathway, anterograde conduction over the pathway was absent in 41 (64%), intermittent in 5 (8%) and nondecremental in 18 (28%). In the remaining five patients, anterograde and retrograde decremental conduction over the same pathway was found. The anterograde and retrograde conduction properties and extent of decrement did not differ between anterograde and retrograde decremental pathways. Posteroseptal pathways had the highest incidences of anterograde and retrograde decremental conduction. Intravenous adenosine, procainamide and verapamil caused conduction delay or block, or both, in 10 of 10, 10 of 10 and 4 of 10 of the anterograde and 20 of 20, 20 of 20 and 8 of 20 of the retrograde decremental pathways, respectively. All patients had successful ablation of the decremental pathways without complications. During the follow-up period of 31 +/- 19 months, only one patient experienced recurrence. CONCLUSIONS: Decremental accessory pathways usually had functionally distinct conduction characteristics in the anterograde and retrograde directions. Their pharmacologic responses suggested the heterogeneous mechanisms of decremental conduction.

Adenosine↗